Surgical device, outer tube, endoscope, and treatment tool

ABSTRACT

A surgical device, an outer tube, an endoscope, and a treatment tool that have a compact configuration and achieve high durability are provided. The outer tube includes a slider in an outer tube body. When the endoscope and the treatment tool are inserted into the outer tube, and are held by an endoscope holding part and a treatment tool holding part each being provided in the slider, and are combined into a single unit. Consequently, when the treatment tool is moved in the axial direction, the endoscope is moved in the axial direction in interlock with the movement. Because the outer tube is configured such that the endoscope exit port has an inner diameter that is smaller than the inner diameter of the elastic member provided to hold the endoscope at the endoscope holding part, the strength of the endoscope can be secured while preventing interference with the treatment tool.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a Continuation of PCT International Application No.PCT/JP2014/058777 filed on Mar. 27, 2014, which claims priority under 35U.S.C. § 119(a) to Japanese Patent Application No. 2013-074013 filed onMar. 29, 2013. Each of the above application(s) is hereby expresslyincorporated by reference, in its entirety, into the presentapplication.

BACKGROUND OF THE INVENTION

Field of the Invention

The present invention relates to a surgical device that uses an outertube to guide multiple medical instruments (e.g., an endoscope and atreatment tool) into a body cavity.

Description of the Related Art

A laparoscope has been known as an endoscopic instrument that isinserted from the skin on a body surface into an abdominal cavity. Asurgery (laparoscopic surgery) using this laparoscope only requires asmaller surgical wound than laparotomy and thoracotomy do, and canreduce the post-operation bed rest period. Consequently, such a surgeryhas recently been widespread in many operations.

Typically, in a laparoscopic surgery (e.g., laparoscopic cholecystectomyetc.), an operator who performs treatment and a laparoscopist whooperates a laparoscope are present. The treatment and the operation ofthe laparoscope are separately performed. Consequently, during theoperation, the operator performs treatment while successivelyinstructing the laparoscopist in order to obtain an optimal image fortreatment.

However, according to the scheme where the operator instructs thelaparoscopist, it is difficult to obtain an image which the operatoractually wishes, thereby causing a problem in that stress is applied tothe operator. Furthermore, the laparoscopist performs an operation afterthe operator issues an instruction, thereby causing another problem inthat the operation requires time. Moreover, a hand of the operator and ahand of the laparoscopist sometimes interfere with each other above theabdominal wall of a patient, thereby causing yet another problem in thatthe operation becomes complicated.

Japanese Patent Application Laid-Open No. 2007-301378 (PTL 1) describesa technique as a configuration that allows a treatment tool and anendoscope to move in interlock with each other. The technique detectsthe amount of insertion and inclination of the treatment tool, controlsoptical zooming and electronic zooming of the endoscope to cause theimaging range of the endoscope to follow the movement of the treatmenttool.

Furthermore, Japanese Patent Application Laid-Open No. 10-118076 (PTL 2)and Japanese Patent Application Laid-Open No. 2007-222239 (PTL 3)describe a technique that provides a marker at a distal end part of atreatment tool, detects the position of the marker to thereby detect theposition of the treatment tool, and causes the imaging range of theendoscope to follow the movement of the treatment tool.

Moreover, Japanese Patent Application Laid-Open No. 8-164148 (PTL 4)describes a technique that causes a magnetic sensor provided for atreatment tool to detect the position of the treatment tool, and allowsthe imaging range of an endoscope to follow the movement of thetreatment tool.

SUMMARY OF THE INVENTION

However, the method that detects the position or the like of thetreatment tool and causes the imaging range of the endoscope to followthe movement of the treatment tool as with the conventional case has aproblem in that the scale of the system becomes large.

The present invention is made in view of such situations, and aims toprovide a surgical device, an outer tube, an endoscope, and a treatmenttool that have a compact configuration and high durability.

Solutions to the problem are as follows.

A first aspect is a surgical device including: a first medicalinstrument that includes an insertion part; a second medical instrumentthat includes an insertion part; and an outer tube into which theinsertion part of the first medical instrument and the insertion part ofthe second medical instrument are inserted, and is configured to guidethe insertion part of the first medical instrument and the insertionpart of the second medical instrument into a body cavity, wherein theouter tube comprises: a cylindrical outer tube body into which theinsertion part of the first medical instrument and the insertion part ofthe second medical instrument are inserted; a first entry port providedat a proximal end part of the outer tube body; a second entry portprovided at the proximal end part of the outer tube body; a first exitport provided at a distal end part of the outer tube body; a second exitport provided at the distal end part of the outer tube body; a movableobject which is arranged in the outer tube body and is configured to bemovable in the outer tube body in an axial direction; a first holdingpart which is provided at the movable object and configured to hold theinsertion part of the first medical instrument inserted into the outertube body; and a second holding part which is provided at the movableobject and configured to hold the insertion part of the second medicalinstrument inserted into the outer tube body, and the insertion part ofthe first medical instrument comprises: a part which is to be held bythe first holding part and has a first diameter A1; and a part which isdisposed closer to a distal end than (on a distal end side with respectto) the part having the first diameter A1, and is configured to bedelivered to protrude out of the first exit port, and has a seconddiameter A2 smaller than the first diameter A1.

According to this aspect, the first medical instrument and the secondmedical instrument are inserted into the body cavity through the outertube. The outer tube is configured to include the cylindrical outer tubebody and the movable object arranged in the outer tube body. When thefirst medical instrument and the second medical instrument are insertedinto the outer tube body, these instruments are held by the firstholding part and the second holding part provided at the movable object,so as to be integrated. The movable object is configured to be movablealong the axis of the outer tube body. When the first medical instrumentis moved in the axial direction, the second medical instrument is movedin interlock with the movement. Likewise, when the second medicalinstrument is moved in the axial direction, the first medical instrumentis moved in interlock with the movement. In this case, for example, ifthe first medical instrument is the endoscope and the second medicalinstrument is the treatment tool, the endoscope can be moved ininterlock with the movement of the treatment tool. This movement allowsthe visual field (imaging region) of the endoscope to follow thetreatment portion, thereby allowing the operator to be always providedwith an image optimal to treatment. That is, the image desired by theoperator can be displayed without stress. Furthermore, the first medicalinstrument and the second medical instrument are inserted into the bodycavity through the outer tube. Consequently, only a single site to bepunctured into the body cavity wall is required. Therefore, alow-invasive operation (operation with a small load to the body) can beperformed. Note that the first medical instrument visual field is movedin the forward and rear direction (to-and-fro movement) by movement ofthe second medical instrument in the axial direction. Meanwhile, themovement in the vertical and horizontal directions is performed by theinclination movement of the second medical instrument. That is, all theportions including the outer tube are inclined to move the visual field.In this case, because the inclination movement of the outer tube canmove the visual field, the incision is not required to be enlarged toperform treatment or move the visual field. Therefore, the low-invasiveoperation can be performed.

According to this aspect, the insertion part of the first medicalinstrument includes: the part which is to be held by the first holdingpart and has the first diameter A1; and the part which is disposedcloser to the distal end than (on the distal end side with respect to)the part having the first diameter A1, is to be delivered to protrudeout of the first exit port, and has a second diameter A2. The seconddiameter A2 is formed smaller than the first diameter A1. In order toperform a low-invasive operation, the diameter of the outer tube isrequired to be reduced. If the first medical instrument and the secondmedical instrument are inserted into the single outer tube, the distancebetween the first medical instrument and the second medical instrumentis required to be reduced as small as possible in order to reduce thediameter of the outer tube. However, when these instruments are arrangedtoo close to each other, the instruments may interfere with each other.That is, for example, if the first medical instrument is an endoscopeand the second medical instrument is a treatment tool, too closearrangement of both the instruments sometimes causes the treatment toolto block the visual field of the endoscope and reduces the visual field.The reduction in the diameter of the distal end can secure the distancebetween the centers of axes of both the elements, and prevent theinterference with each other (the range where the endoscope visual fieldis reduced can be decreased). Here, when the diameter is reduced, thestrength of the medical instrument cannot be secured (the durability isreduced). However, the part of the medical instrument that requires thestrength is on the proximal end side, particularly, the part to be heldby the holding part. Thus, increase in the diameter of the part to beheld by the holding part can attain the narrowed diameter of therequired part (distal end part) while maintaining the strength as awhole.

Note that it is preferable that the part where the diameter of theinsertion part is varied be formed so as to allow the diameter to besmoothly varied.

A second aspect is a mode of the surgical device according to the firstaspect, wherein the insertion part of the second medical instrumentincludes: a part which is to be held by the second holding part and hasa first diameter B1; and a part which is disposed closer to a distal endthan (on a distal end side with respect to) the part having the firstdiameter B1, and is configured to be delivered to protrude out of thesecond exit port, and has a second diameter B2 smaller than the firstdiameter B1.

According to this aspect, the second medical instrument is formed aswith the first medical instrument. Consequently, the interferencebetween the first medical instrument and the second medical instrumentcan be further prevented.

Here, also for the second medical instrument, it is preferable that thepart where the diameter of the insertion part varied be formed so as toallow the diameter to be smoothly varied.

A third aspect is a mode of the surgical device according to the firstor second aspect, wherein the first medical instrument is an endoscope.

According to this aspect, the first medical instrument is configured bythe endoscope. Consequently, the endoscope can be moved in interlockwith the movement of the second medical instrument (e.g., treatmenttool). Therefore, an image optimal to treatment can be always providedfor the operator, and the image desired by the operator can be displayedwithout stress.

A fourth aspect is a mode of the surgical device according to the thirdaspect, wherein the endoscope internally includes an imaging device(imaging means) at a distal end of the insertion part.

According to this aspect, the imaging device is internally included atthe distal end of the insertion part of the endoscope.

A fifth aspect is a mode of the surgical device according to the firstor second aspect, wherein the first medical instrument is a treatmenttool.

According to this aspect, the first medical instrument is configured bythe treatment tool. Consequently, the second medical instrument (e.g.,endoscope) can be moved in interlock with the movement of the treatmenttool.

A sixth aspect is a mode of the surgical device according to any one ofthe first to fifth aspects, wherein the first holding part can adjust aholding position of the insertion part of the first medical instrument.

According to this aspect, the position of the insertion part of thefirst medical instrument held by the first holding part can be adjustedin the axial direction. Consequently, the relative positionalrelationship (the positional relationship of the distal end) between thefirst medical instrument and the second medical instrument that areconnected via the movable object can be adjusted. Accordingly, forexample, if the first medical instrument or the second medicalinstrument is configured by an endoscope, the imaging range can beadjusted and the usability can be improved.

A seventh aspect is a mode of the surgical device according to any oneof the first to sixth aspects, wherein the second holding part canadjust a holding position of the insertion part of the second medicalinstrument.

According to this aspect, the position of the insertion part of thesecond medical instrument held by the second holding part can beadjusted in the axial direction. Consequently, the relative positionalrelationship (the positional relationship of the distal end) between thefirst medical instrument and the second medical instrument that areconnected via the movable object can be adjusted. Accordingly, forexample, if the first medical instrument or the second medicalinstrument is configured by an endoscope, the imaging range can beadjusted and the usability can be improved.

An eighth aspect is a mode of the surgical device according to any oneof the first to seventh aspects, wherein the first holding part includesan annular elastic member through which the insertion part of the firstmedical instrument is inserted, and which is configured to hold theinsertion part of the first medical instrument by means of an elasticforce, and the first exit port has an inner diameter smaller than aninner diameter of the elastic member.

According to this aspect, the first holding part includes an annularelastic member. The insertion part of the first medical instrument isinserted into the annular elastic member, thereby allowing the firstmedical instrument to be held by the first holding part. Because theholding is a holding by means of the elastic force of the elasticmember, the holding position of the first medical instrument can befreely adjusted. Therefore, in conformity with the preference of theoperator, the positional relationship between the first medicalinstrument and the second medical instrument can be freely adjusted. Theouter tube is configured such that the inner diameter of the first exitport is smaller than the inner diameter of the elastic member.

A ninth aspect is a mode of the surgical device according to any one ofthe first to eighth aspects, wherein the movable object includes: amovable object main body configured to be movable with respect to theouter tube body in the axial direction; and a movable part configured tobe movable with respect to the movable object main body in the axialdirection, and one of the first holding part and the second holding partis provided in the movable part, and another one of the first holdingpart and the second holding part is provided in the movable object mainbody.

According to this aspect, the movable object is configured to includethe movable object main body configured to be movable in the axialdirection with respect to the outer tube body, and the movable partconfigured to be movable in the axial direction with respect to themovable object main body. One of the first holding part and the secondholding part is provided in the movable part, and another one of thefirst holding part and the second holding part is provided in themovable object main body. Consequently, interlocked movement of thefirst medical instrument and the second medical instrument can have“play (non-sensitive region)”. That is, within a predetermined range(movable range), the movement of the first medical instrument can beprevented from being transmitted to the second medical instrument (themovement of the second medical instrument can be prevented from beingtransmitted to the first medical instrument). Such interlocked movementof the first medical instrument and the second medical instrument isthus provided with “play”. Consequently, for example, in the case wherethe first medical instrument is configured by an endoscope, minutemovement of the second medical instrument in the axial direction(to-and-fro movement with a small amplitude and the like) can beprevented from being transmitted to the endoscope. Therefore, the imageon the screen can be prevented from swaying due to minute movement ofthe second medical instrument. An easily viewable image can be alwaysprovided for the operator.

A tenth aspect is a mode of the surgical device according to the ninthaspect, wherein the movable object main body is configured to have agreater movement resistance to the outer tube body than a movementresistance of the movable part to the movable object main body.

According to this aspect, if the movable object is configured to includethe movable object main body and the movable part, the movable objectmain body is configured to have a movement resistance (resistanceapplied during movement) to the outer tube body that is larger than themovement resistance of the movable part to the movable object main body.Consequently, the minute vibrations of the first medical instrument orthe second medical instrument in the axial direction can be absorbed bythe slide of the movable part against the movable object main body.

An eleventh aspect is a mode of the surgical device according to any oneof the first to tenth aspects, wherein the outer tube further includes afirst sealing member which is provided at the first entry port andconfigured to slidably seal the insertion part of the first medicalinstrument, and the insertion part of the first medical instrumentfurther includes a part which is disposed closer to a proximal end thanthe part having the first diameter A1, and is configured to maintainhermeticity with the first sealing member, and has a third diameter A3smaller than the first diameter A1.

According to this aspect, the insertion part of the first medicalinstrument further includes the part which is disposed closer to theproximal end than (on the proximal end side with respect to) the parthaving the first diameter A1, and is configured to maintain hermeticitywith the first sealing member, and has the third diameter A3, and thethird diameter A3 is formed smaller than the first diameter A1.Consequently, when the first medical instrument is moved in the axialdirection, the sliding friction applied to the first sealing member canbe reduced. Therefore, the force required when the first medicalinstrument is moved can be reduced. Furthermore, the movement of thefirst medical instrument can be smoothed accordingly.

A twelfth aspect is a mode of the surgical device according to any oneof the first to tenth aspects, wherein the outer tube further includes afirst sealing member which is provided at the first entry port, andconfigured to slidably seal the insertion part of the first medicalinstrument, and the insertion part of the first medical instrumentfurther includes a part which is disposed closer to a proximal end thanthe part having the first diameter A1, and is configured to maintainhermeticity with the first sealing member, and has a third diameter A3larger than the first diameter A1.

According to this aspect, the insertion part of the first medicalinstrument further includes the part which is disposed closer to theproximal end than (on the proximal end side with respect to) the parthaving the first diameter A1, and is configured to maintain hermeticitywith the first sealing member, and has the third diameter A3, and thethird diameter A3 is formed larger than the first diameter A1.Consequently, the insertion and extraction operation of the firstmedical instrument into and from the outer tube can be easily performed.That is, such a configuration can eliminate the sliding friction appliedfrom the first sealing member during insertion and extraction of thefirst medical instrument at the distal end part side of the firstmedical instrument. Consequently, the insertion and extraction operationof the first medical instrument can be smoothly performed withoutunnecessary force.

A thirteenth aspect is a mode of the surgical device according to thesecond aspect, wherein the outer tube further includes a second sealingmember which is provided at the second entry port, and configured toslidably seal the insertion part of the second medical instrument, andthe insertion part of the second medical instrument further includes apart which is disposed closer to a proximal end than the part having thefirst diameter B1, and is configured to maintain hermeticity with thesecond sealing member, and has a third diameter B3 smaller than thefirst diameter B1.

According to this aspect, the insertion part of the second medicalinstrument further includes the part which is disposed closer to theproximal end than (on the proximal end side with respect to) the parthaving the first diameter B1, and is configured to maintain hermeticitywith the second sealing member, and has the third diameter B3, and thethird diameter B3 is formed smaller than the first diameter B1.Consequently, when the second medical instrument is moved in the axialdirection, the sliding friction applied to the second sealing member canbe reduced. Therefore, the force required when the second medicalinstrument is moved can be reduced. Furthermore, the movement of thesecond medical instrument can be smoothed accordingly.

A fourteenth aspect is a mode of the surgical device according to thesecond aspect, wherein the outer tube further includes a second sealingmember which is provided at the second entry port, and configured toslidably seal the insertion part of the second medical instrument, andthe insertion part of the second medical instrument further includes apart which is disposed closer to a proximal end than the part having thefirst diameter B1, and is configured to maintain hermeticity with thesecond sealing member, and has a third diameter B3 larger than the firstdiameter B1.

According to this aspect, the insertion part of the second medicalinstrument further includes the part which is disposed closer to theproximal end than (on the proximal end side with respect to) the parthaving the first diameter B1, and is configured to maintain hermeticitywith the second sealing member, and has the third diameter B3. The thirddiameter B3 is formed larger than the first diameter B1. Consequently,the insertion and extraction operation of the second medical instrumentinto and from the outer tube can be easily performed. That is, such aconfiguration can eliminate the sliding friction applied from the secondsealing member during insertion and extraction of the second medicalinstrument at the distal end part side of the second medical instrument.Consequently, the insertion and extraction operation of the secondmedical instrument can be smoothly performed without unnecessary force.

A fifteenth aspect is an outer tube into which an insertion part of afirst medical instrument and an insertion part of a second medicalinstrument are inserted, and is configured to guide the insertion partof the first medical instrument and the insertion part of the secondmedical instrument into a body cavity, the outer tube including: acylindrical outer tube body into which the insertion part of the firstmedical instrument and the insertion part of the second medicalinstrument are inserted; a first entry port provided at a proximal endpart of the outer tube body; a second entry port provided at theproximal end part of the outer tube body; a first exit port provided ata distal end part of the outer tube body; a second exit port provided atthe distal end part of the outer tube body; a movable object which isarranged in the outer tube body and is configured to be movable in theouter tube body in an axial direction; a first holding part which isprovided at the movable object and configured to hold the insertion partof the first medical instrument inserted into the outer tube body; and asecond holding part which is provided at the movable object andconfigured to hold the insertion part of the second medical instrumentinserted into the outer tube body, wherein the insertion part of thefirst medical instrument includes: a part which is to be held by thefirst holding part and has a first diameter A1; and a part which isdisposed closer to a distal end than the part having the first diameterA1, and is configured to be delivered to protrude out of the first exitport, and has a second diameter A2 smaller than the first diameter A1.

According to this aspect, the outer tube is configured to include thecylindrical outer tube body, and the movable object arranged in theouter tube body. When the first medical instrument and the secondmedical instrument are inserted into the outer tube body, theseinstruments are held by the first holding part and the second holdingpart provided at the movable object, so as to be integrated. The movableobject is configured to be movable along the axis of the outer tubebody. When the first medical instrument is moved in the axial direction,the second medical instrument is moved in interlock with the movement.Likewise, when the second medical instrument is moved in the axialdirection, the first medical instrument is moved in interlock with themovement. In this case, for example, if the first medical instrument isthe endoscope and the second medical instrument is the treatment tool,the endoscope can be moved in interlock with the movement of thetreatment tool. This movement allows the visual field (imaging region)of the endoscope to follow the treatment portion, thereby allowing theoperator to be always provided with an image optimal to treatment. Thatis, the image desired by the operator can be displayed without stress.Furthermore, the first medical instrument and the second medicalinstrument are inserted into the body cavity through the outer tube.Consequently, only a single site to be punctured into the body cavitywall is required. Therefore, the low-invasive operation (operation witha small load to the body) can be performed. Note that the first medicalinstrument visual field is moved in the forward and rear direction(to-and-fro movement) by movement of the second medical instrument inthe axial direction. The movement in the vertical and horizontaldirections is performed by the inclination movement of the secondmedical instrument. That is, all the parts including the outer tube areinclined to move the visual field. In this case, the inclinationmovement of the outer tube can move the visual field. Consequently, theincision is not required to be enlarged to perform treatment or move thevisual field. Therefore, the low-invasive operation can be performed.

According to this aspect, the insertion part of the first medicalinstrument includes: the part which is to be held by the first holdingpart and has the first diameter A1; and the part which is disposedcloser to the distal end than (on the distal end side with respect to)the part having the first diameter A1, is configured to be delivered toprotrude out of the first exit port, and has the second diameter A2, andthe second diameter A2 is formed smaller than the first diameter A1. Inorder to perform a low-invasive operation, the diameter of the outertube is required to be reduced. If the first medical instrument and thesecond medical instrument are inserted into the single outer tube, thedistance between the first medical instrument and the second medicalinstrument is required to be reduced as small as possible in order toreduce the diameter of the outer tube. However, when these instrumentsare arranged too close to each other, the instruments may be interferewith each other. That is, for example, if the first medical instrumentis an endoscope, and the second medical instrument is a treatment tool,too close arrangement of both the instruments sometimes causes thetreatment tool to block the visual field of the endoscope and reducesthis visual field. The reduction in the diameter of the distal end cansecure the distance between the centers of axes of both the instruments,and prevent the interference with each other (the range where theendoscope visual field is reduced can be decreased). Here, when thediameter is reduced, the strength of the medical instrument cannot besecured (the durability is reduced). However, the part of the medicalinstrument that requires the strength is on the proximal end side,particularly, the part to be held by the holding part. Consequently,increase in the diameter of the part to be held by the holding part canattain the narrowed diameter of the required part (distal end part)while maintaining the strength as a whole.

Note that it is preferable that the part where the diameter of theinsertion part is varied be formed so as to allow the diameter to besmoothly varied.

A sixteenth aspect is a mode of the outer tube according to thefifteenth aspect, wherein the insertion part of the second medicalinstrument includes: a part which is to be held by the second holdingpart and has a first diameter B1; and a part which is disposed closer toa distal end than (on a distal end side with respect to) the part havingthe first diameter B1, and is configured to be delivered to protrude outof the second exit port, and has a second diameter B2, and the seconddiameter B2 is smaller than the first diameter B1.

According to this aspect, the second medical instrument is also formedas with the first medical instrument. Consequently, the interferencebetween the first medical instrument and the second medical instrumentcan be further prevented.

Here, also for the second medical instrument, it is preferable that thepart where the diameter of the insertion part varied be formed so as toallow the diameter to be smoothly varied.

A seventeenth aspect is a mode of the outer tube according to thefifteenth or sixteenth aspect, wherein the first medical instrument isan endoscope.

According to this aspect, the first medical instrument is configured bythe endoscope. Consequently, the endoscope can be moved in interlockwith the movement of the second medical instrument (e.g., treatmenttool). Therefore, an image optimal to treatment can be always providedfor the operator, and the image desired by the operator can be displayedwithout stress.

An eighteenth aspect is a mode of the outer tube according to theseventeenth aspect, wherein the endoscope internally includes an imagingdevice (imaging means) at a distal end of the insertion part.

According to this aspect, the imaging device is internally included atthe distal end of the insertion part of the endoscope.

A nineteenth aspect is a mode of the outer tube according to thefifteenth or sixteenth aspect, wherein the first medical instrument is atreatment tool.

According to this aspect, the first medical instrument is configured bythe treatment tool. Consequently, the first medical instrument (e.g.,endoscope) can be moved in interlock with the movement of the treatmenttool.

A twentieth aspect is a mode of the outer tube according to any one ofthe fifteenth to nineteenth aspects, wherein the first holding part canadjust a holding position of the insertion part of the first medicalinstrument.

According to this aspect, the position of the insertion part of thefirst medical instrument held by the first holding part can be adjustedin the axial direction. Consequently, the relative positionalrelationship (the positional relationship of the distal end) between thefirst medical instrument and the second medical instrument that areconnected via the movable object can be adjusted. Accordingly, forexample, if the first medical instrument or the second medicalinstrument is configured by an endoscope, the imaging range can beadjusted and the usability can be improved.

A twenty-first aspect is a mode of the outer tube according to any oneof the fifteenth to twentieth aspects, wherein the second holding partcan adjust a holding position of the insertion part of the secondmedical instrument.

According to this aspect, the position of the insertion part of thesecond medical instrument held by the second holding part can beadjusted in the axial direction. Consequently, the relative positionalrelationship (the positional relationship of the distal end) between thefirst medical instrument and the second medical instrument that areconnected via the movable object can be adjusted. Accordingly, forexample, if the first medical instrument or the second medicalinstrument is configured by an endoscope, the imaging range can beadjusted and the usability can be improved.

A twenty-second aspect is a mode of the outer tube according to any oneof the fifteenth to twenty-first aspects, wherein the first holding partincludes an annular elastic member through which the insertion part ofthe first medical instrument is inserted, and which is configured tohold the insertion part of the first medical instrument by means of anelastic force, and the first exit port has a smaller inner diameter thanan inner diameter of the elastic member.

According to this aspect, the first holding part includes the annularelastic member. The insertion part of the first medical instrument isinserted into the annular elastic member, thereby allowing the firstmedical instrument to be held by the first holding part. Because theholding is a holding by means of the elastic force of the elasticmember, the holding position of the first medical instrument can befreely adjusted. Therefore, in conformity with the preference of theoperator, the positional relationship between the first medicalinstrument and the second medical instrument can be freely adjusted. Theouter tube is configured such that the inner diameter of the first exitport is smaller than the inner diameter of the elastic member.

A twenty-third aspect is a mode of the outer tube according to any oneof the fifteenth to twenty-second aspects, wherein the movable objectincludes: a movable object main body configured to be movable withrespect to the outer tube body in the axial direction; and a movablepart configured to be movable with respect to the movable object mainbody in the axial direction, and one of the first holding part and thesecond holding part is provided in the movable part, and another one ofthe first holding part and the second holding part is provided in themovable object main body.

According to this aspect, the movable object is configured to includethe movable object main body configured to be movable in the axialdirection with respect to the outer tube body, and the movable partconfigured to be movable in the axial direction with respect to themovable object main body. One of the first holding part and the secondholding part is provided in the movable part, and another one of thefirst holding part and the second holding part is provided in themovable object main body. Consequently, interlocked movement of thefirst medical instrument and the second medical instrument can have“play (non-sensitive region)”. That is, within a predetermined range(movable range), the movement of the first medical instrument can beprevented from being transmitted to the second medical instrument (themovement of the second medical instrument can be prevented from beingtransmitted to the first medical instrument). Such interlocked movementof the first medical instrument and the second medical instrument isthus provided with “play”. Consequently, for example, in the case wherethe first medical instrument is configured by the endoscope, minutemovement of the second medical instrument in the axial direction(to-and-fro movement with a small amplitude and the like) can beprevented from being transmitted to the endoscope. Therefore, the imageon the screen can be prevented from swaying due to minute movement ofthe second medical instrument. An easily viewable image can be alwaysprovided for the operator.

A twenty-fourth aspect is a mode of the outer tube according to thetwenty-third aspect, wherein the movable object main body is configuredto have a greater movement resistance to the outer tube body than amovement resistance of the movable part to the movable object main body.

According to this aspect, if the movable object is configured to includethe movable object main body and the movable part, the movable objectmain body is configured to have a movement resistance (resistanceapplied during movement) to the outer tube body that is larger than themovement resistance of the movable part to the movable object main body.Consequently, the minute vibrations of the first medical instrument orthe second medical instrument in the axial direction can be absorbed bythe slide of the movable part against the movable object main body.

A twenty-fifth aspect is a mode of the outer tube according to any oneof the fifteenth to twenty-fourth aspects, wherein the outer tubefurther includes a first sealing member which is provided at the firstentry port and configured to slidably seal the insertion part of thefirst medical instrument, and the insertion part of the first medicalinstrument further includes a part which is disposed closer to aproximal end than the part having the first diameter A1, and isconfigured to maintain hermeticity with the first sealing member, andhas a third diameter A3 smaller than the first diameter A1.

According to this aspect, the insertion part of the first medicalinstrument further includes the part which is disposed closer to theproximal end than (on the proximal end side with respect to) the parthaving the first diameter A1, and is configured to maintain hermeticitywith the first sealing member, and has the third diameter A3, and thethird diameter A3 is formed smaller than the first diameter A1.Consequently, when the first medical instrument is moved in the axialdirection, the sliding friction applied to the first sealing member canbe reduced. Therefore, the force required when the first medicalinstrument is moved can be reduced. Furthermore, the movement of thefirst medical instrument can be smoothed accordingly.

A twenty-sixth aspect is a mode of the outer tube according to thefifteenth to twenty-fourth aspects, wherein the outer tube furtherincludes a first sealing member which is provided at the first entryport, and configured to slidably seal the insertion part of the firstmedical instrument, and the insertion part of the first medicalinstrument further includes a part which is disposed closer to aproximal end than the part having the first diameter A1, and isconfigured to maintain hermeticity with the first sealing member, andhas a third diameter A3 larger than the first diameter A1.

According to this aspect, the insertion part of the first medicalinstrument further includes the part which is disposed closer to theproximal end than (on the proximal end side with respect to) the parthaving the first diameter A1, and is configured to maintain hermeticitywith the first sealing member, and has the third diameter A3, and thethird diameter A3 is formed larger than the first diameter A1.Consequently, the insertion and extraction operation of the firstmedical instrument into and from the outer tube can be easily performed.That is, such a configuration can eliminate the sliding friction appliedfrom the first sealing member during insertion and extraction of thefirst medical instrument at the distal end part side of the firstmedical instrument. Consequently, the insertion and extraction operationof the first medical instrument can be smoothly performed withoutunnecessary force.

A twenty-seventh aspect is a mode of the outer tube according to thesixteenth aspect, wherein the outer tube further includes a secondsealing member which is provided at the second entry port, andconfigured to slidably seal the insertion part of the second medicalinstrument, and the insertion part of the second medical instrumentfurther includes a part which is disposed closer to a proximal end thanthe part having the first diameter B1, and is configured to maintainhermeticity with the second sealing member, and has a third diameter B3smaller than the first diameter B1.

According to this aspect, the insertion part of the second medicalinstrument further includes the part which is disposed closer to theproximal end than (on the proximal end side with respect to) the parthaving the first diameter B1, and is configured to maintain hermeticitywith the second sealing member, and has the third diameter B3, and thethird diameter B3 is formed smaller than the first diameter B1.Consequently, when the second medical instrument is moved in the axialdirection, the sliding friction applied to the second sealing member canbe reduced. Therefore, the force required when the second medicalinstrument is moved can be reduced. Furthermore, the movement of thesecond medical instrument can be smoothed accordingly.

A twenty-eighth aspect is a mode of the outer tube according to thesixteenth aspect, wherein the outer tube further includes a secondsealing member which is provided at the second entry port, andconfigured to slidably seal the insertion part of the second medicalinstrument, and the insertion part of the second medical instrumentfurther includes a part which is disposed closer to a proximal end thanthe part having the first diameter B1, and is configured to maintainhermeticity with the second sealing member, and has a third diameter B3larger than the first diameter B1.

According to this aspect, the insertion part of the second medicalinstrument further includes the part which is disposed closer to theproximal end than (on the proximal end side with respect to) the parthaving the first diameter B1, and is configured to maintain hermeticitywith the second sealing member, and has the third diameter B3. The thirddiameter B3 is formed larger than the first diameter B1. Consequently,the insertion and extraction operation of the second medical instrumentinto and from the outer tube can be easily performed. That is, such aconfiguration can eliminate the sliding friction applied from the secondsealing member during insertion and extraction of the second medicalinstrument at the distal end part side of the second medical instrument.Consequently, the insertion and extraction operation of the secondmedical instrument can be smoothly performed without unnecessary force.

A twenty-ninth aspect is an endoscope to be inserted into a body cavitythrough an outer tube which includes: a cylindrical outer tube body intowhich an insertion part of the endoscope and an insertion part of atreatment tool are inserted; an endoscope entry port provided at aproximal end part of the outer tube body; a treatment tool entry portprovided at the proximal end part of the outer tube body; an endoscopeexit port provided at a distal end part of the outer tube body; atreatment tool exit port provided at the distal end part of the outertube body; a movable object which is arranged in the outer tube body andconfigured to be movable in the outer tube body in an axial direction;an endoscope holding part which is provided at the movable object andconfigured to hold the insertion part of the endoscope inserted into theouter tube body; and a treatment tool holding part which is provided atthe movable object and configured to hold the insertion part of thetreatment tool inserted into the outer tube body, wherein the insertionpart includes: a part which is to be held by the endoscope holding partand has a first diameter A1; and a part which is disposed closer to adistal end than the part having the first diameter A1, and is configuredto be delivered to protrude out of the endoscope exit port, and has asecond diameter A2 smaller than the first diameter A1.

According to this aspect, the insertion part of the endoscope includes:the part which is to be held by the endoscope holding part and has thefirst diameter A1; and the part which is disposed closer to the distalend than (on the distal end side with respect to) the part having thefirst diameter A1, is configured to be delivered to protrude out of theendoscope exit port, and has the second diameter A2, and the seconddiameter A2 is formed smaller than the first diameter A1. In order toperform a low-invasive operation, the diameter of the outer tube isrequired to be reduced. If the endoscope and the treatment tool areinserted into the single outer tube, the distance between the endoscopeand the treatment tool is required to be reduced as small as possible inorder to reduce the diameter of the outer tube. However, theseinstruments are arranged too close to each other, the treatment tool maysometimes block the visual field of the endoscope and reduces thisvisual field. The reduction in the diameter of the distal end can securethe distance between the centers of axes of both the elements, and therange where the endoscope visual field is reduced can be decreased.Here, when the diameter is reduced, the strength of the endoscope cannotbe secured (the durability is reduced). However, the part of theendoscope that requires the strength is on the proximal end side,particularly, the part to be held by the endoscope holding part.Consequently, increase in the diameter of the part to be held by theendoscope holding part can attain the narrowed diameter of the requiredpart (distal end part) while maintaining the strength as a whole.

Note that it is preferable that the part where the diameter of theinsertion part is varied be formed so as to allow the diameter to besmoothly varied.

A thirtieth aspect is a mode of the endoscope according to thetwenty-ninth aspect, wherein an imaging device (imaging means) isinternally included at a distal end of the insertion part.

According to this aspect, the endoscope internally includes the imagingdevice at the distal end of the insertion part.

A thirty-first aspect is a mode of the endoscope according to thetwenty-ninth or thirtieth aspect, wherein the outer tube furtherincludes an endoscope sealing member which is provided at the endoscopeentry port, and configured to slidably seal the insertion part of theendoscope, and the insertion part of the endoscope further includes apart which is disposed closer to a proximal end than the part having thefirst diameter A1, and is configured to maintain hermeticity with theendoscope sealing member, and has a third diameter A3 smaller than thefirst diameter A1.

According to this aspect, the insertion part of the endoscope furtherincludes the part which is disposed closer to the proximal end than (onthe proximal end side with respect to) the part having the firstdiameter A1, and is configured to maintain hermeticity with theendoscope sealing member, and has the third diameter A3, and the thirddiameter A3 is formed smaller than the first diameter A1. Consequently,when the endoscope is moved in the axial direction, the sliding frictionapplied to the endoscope sealing member can be reduced. Therefore, theforce required when the endoscope is moved can be reduced. Furthermore,the movement of the endoscope can be smoothed accordingly.

A thirty-second aspect is a mode of the endoscope according to thetwenty-ninth or thirtieth aspect, wherein the outer tube furtherincludes an endoscope sealing member which is provided at the endoscopeentry port, and is configured to slidably seal the insertion part of theendoscope, and the insertion part of the endoscope further includes apart which is disposed closer to a proximal end than the part having thefirst diameter A1, and is configured to maintain hermeticity with theendoscope sealing member, and has a third diameter A3 larger than thefirst diameter A1.

According to this aspect, the insertion part of the endoscope furtherincludes the part which is disposed closer to the proximal end than (onthe proximal end side with respect to) the part having the firstdiameter A1, and is configured to maintain hermeticity with theendoscope sealing member, and has the third diameter A3, and the thirddiameter A3 is formed larger than the first diameter A1. Consequently,the insertion and extraction operation of the endoscope into and fromthe outer tube can be easily performed. That is, such a configurationcan eliminate the sliding friction applied from the endoscope sealingmember during insertion and extraction of the endoscope at the distalend part side of the endoscope. Consequently, the insertion andextraction operation of the endoscope can be smoothly performed withoutunnecessary force.

A thirty-third aspect is a treatment tool to be inserted into a bodycavity through an outer tube which includes: a cylindrical outer tubebody through which an insertion part of an endoscope and an insertionpart of the treatment tool are inserted; an endoscope entry portprovided at a proximal end part of the outer tube body; a treatment toolentry port provided at the proximal end part of the outer tube body; anendoscope exit port provided at a distal end part of the outer tubebody; a treatment tool exit port provided at the distal end part of theouter tube body; a movable object which is arranged in the outer tubebody and configured to be movable in the outer tube body in an axialdirection; an endoscope holding part which is provided at the movableobject and is configured to hold the insertion part of the endoscopeinserted into the outer tube body; and a treatment tool holding partwhich is provided at the movable object and is configured to hold theinsertion part of the treatment tool inserted into the outer tube body,wherein the insertion part includes: a part which is to be held by thetreatment tool holding part and has a first diameter B1; and a partwhich is disposed closer to a distal end than the part having the firstdiameter B1, is configured to be delivered to protrude out of thetreatment tool exit port, and has a second diameter B2 smaller than thefirst diameter B1.

According to this aspect, the insertion part of the treatment toolincludes: the part which is to be held by the treatment tool holdingpart and has the first diameter B1; and the part which is disposedcloser to the distal end than (on the distal end side with respect to)the part having the first diameter B1, and is configured to be deliveredto protrude out of the treatment tool exit port, and has the seconddiameter B2, and the second diameter B2 is formed smaller than the firstdiameter B1. In order to perform a low-invasive operation, the diameterof the outer tube is required to be reduced. If the endoscope and thetreatment tool are inserted into the single outer tube, the distancebetween the endoscope and the treatment tool is required to be reducedas small as possible in order to reduce the diameter of the outer tube.However, when these instruments are arranged too close to each other,the treatment tool may block the visual field of the endoscope andreduces this visual field. The reduction in the diameter of the distalend can secure the distance between the centers of axes of both theelements, and the range where the endoscope visual field is reduced canbe decreased. Here, when the diameter is reduced, the strength of thetreatment tool cannot be secured (the durability is reduced). However,the part of the treatment tool that requires the strength is on theproximal end side, particularly, the part to be held by the treatmenttool holding part. Consequently, increase in the diameter of the part tobe held by the treatment tool holding part can attain the narroweddiameter of the required portion (distal end part) while maintaining thestrength as a whole.

Note that it is preferable that the part where the diameter of theinsertion part is varied be formed so as to allow the diameter to besmoothly varied.

A thirty-fourth aspect is a mode of the treatment tool according to thethirty-third aspect, wherein the outer tube further includes a treatmenttool sealing member that is provided at the treatment tool entry port,and is configured to slidably seal the insertion part of the treatmenttool, the insertion part of the treatment tool further includes a partwhich is disposed closer to a proximal end than the part having thefirst diameter B1, and is configured to maintain hermeticity with thetreatment tool sealing member, and has a third diameter B3 smaller thanthe first diameter B1.

According to this aspect, the insertion part of the treatment toolfurther includes the part which is disposed closer to the proximal endthan (on the proximal end side with respect to) the part having thefirst diameter B1, and is configured to maintain hermeticity with thetreatment tool sealing member, and has the third diameter B3, and thethird diameter B3 is formed smaller than the first diameter B1.Consequently, when the treatment tool is moved in the axial direction,the sliding friction applied to the treatment tool sealing member can bereduced. Therefore, the force required when the treatment tool is movedcan be reduced. Furthermore, the movement of the treatment tool can besmoothed accordingly.

A thirty-fifth aspect is a mode of the treatment tool according to thethirty-third aspect, wherein the outer tube further includes a treatmenttool sealing member that is provided at the treatment tool entry port,and is configured to slidably seal the insertion part of the treatmenttool, and the insertion part of the treatment tool further includes apart which is disposed closer to proximal end than the part having thefirst diameter B1, and is configured to maintain hermeticity with thetreatment tool sealing member, and has a third diameter B3 larger thanthe first diameter B1.

According to this aspect, the insertion part of the treatment toolfurther includes the part which is disposed closer to the proximal endthan (on the proximal end side with respect to) the part having thefirst diameter B1, and is configured to maintain hermeticity with thetreatment tool sealing member, and has the third diameter B3, and thethird diameter B3 is formed larger than the first diameter B1.Consequently, the insertion and extraction operation of the treatmenttool into and from the outer tube can be easily performed. That is, sucha configuration can eliminate the sliding friction applied from thetreatment tool sealing member during insertion and extraction of thetreatment tool at the distal end part side of the treatment tool.Consequently, the insertion and extraction operation of the treatmenttool can be smoothly performed without unnecessary force.

Advantageous Effects of Invention

The present invention can provide a surgical device, an outer tube, anendoscope, and a treatment tool that have the compact configuration andhigh durability.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic configuration diagram of an endoscopic surgicaldevice.

FIG. 2 is a schematic configuration diagram of an endoscope system.

FIG. 3 is a sectional view showing a schematic configuration of theinside of a distal end part of an insertion part of an endoscope.

FIG. 4 is a schematic configuration diagram showing an example of aneedle light.

FIG. 5 is a schematic configuration diagram showing an example of atreatment tool.

FIG. 6 is a side sectional view of an outer tube.

FIG. 7 is a front view of the outer tube.

FIG. 8 is a rear view of the outer tube.

FIG. 9 is an enlarged sectional view of a proximal end part of the outertube.

FIG. 10 is an enlarged sectional view of a distal end part of the outertube.

FIG. 11 is a sectional view taken along 11-11 of FIG. 9.

FIG. 12 is an exploded perspective view showing a schematicconfiguration of a valve member.

FIG. 13 is a side sectional view of the valve member.

FIG. 14 is a schematic diagram showing an example of an operation methodusing the endoscopic surgical device.

FIG. 15 is a side sectional view of an outer tube of a secondembodiment.

FIG. 16 is an enlarged sectional view of a proximal end part of theouter tube of the second embodiment.

FIG. 17 is a sectional view taken along 17-17 of FIG. 16.

FIG. 18 is a side sectional view of an outer tube of another embodiment.

FIG. 19 is an enlarged sectional view of the proximal end parts of anouter tube, an endoscope and a treatment tool of another embodiment.

FIG. 20 is an enlarged sectional view of the proximal end parts of anouter tube, an endoscope and a treatment tool of another embodiment.

FIG. 21 is an enlarged sectional view of the proximal end parts of anouter tube, an endoscope and a treatment tool of another embodiment.

FIG. 22 is a schematic configuration diagram of a main part of anendoscope of another embodiment.

DETAILED DESCRIPTION OF THE EMBODIMENTS

Hereinafter, preferred embodiments of the present invention aredescribed with reference to the accompanying drawings.

<<Configuration of Endoscopic Surgical Device>>

FIG. 1 is a schematic configuration diagram of an endoscopic surgicaldevice.

The endoscopic surgical device 1 as a surgical device is configured toinclude: an endoscope 10 that is to be inserted into a body cavity of apatient and is for observing the inside of the body cavity; a treatmenttool 60 that is to be inserted into the body cavity of the patient andis for performing necessary treatment; and an outer tube 100 for guidingthe endoscope 10 and the treatment tool 60 into the body cavity of thepatient.

<Endoscope>

FIG. 2 is a schematic configuration diagram of an endoscope system.

The endoscope 10 as a medical instrument is an electronic endoscope, andconfigures the endoscope system together with a processor device 30, anda monitor 32.

The endoscope 10 used in the endoscopic surgical device 1 of thisembodiment is a rigid endoscope, such as a laparoscope. The endoscope 10includes a linear-rod-shaped insertion part 12.

The insertion part 12 includes an observation window 14 (see FIG. 3) atits distal end. The endoscope 10 allows observation in the body cavitythrough the observation window 14 at a distal end of the insertion part12.

FIG. 3 is a sectional view showing a schematic configuration of theinside of a distal end part of the insertion part of the endoscope.

As shown in FIG. 3, the insertion part 12 internally includes an imagingdevice 20, which is imaging means, at the distal end part. An imageobserved through the observation window 14 is taken by the imagingdevice 20.

The imaging device 20 is configured to include a lens group 22, a prism24, an image pickup element 26 (CCD (Charge Coupled Device), a CMOS(Complementary Metal Oxide Semiconductor), etc.) and the like.

Subject light entering from the observation window 14 passes through thelens group 22, is subsequently reflected by the prism 24 at asubstantially right angle, and is incident on the light receivingsurface of the image pickup element 26. Consequently, an image observedthrough the observation window 14 is taken by the image pickup element26.

Various signal lines 28 connected to the imaging device 20 are arrangedinside the insertion part 12, and extracted from a proximal end part ofthe insertion part 12 through a cable 16 for the endoscope.

The processor device 30 is a device that integrally controls the entireendoscope system. The processor device 30 is connected to the endoscope10 through the cable 16 for the endoscope extending from the proximalend of the insertion part 12. This device is also connected to themonitor 32 through a cable 34 for the monitor.

Electric power and control signals for operating the imaging device 20are transmitted from the processor device 30 to the endoscope 10. On theother hand, an image signal output from the imaging device 20 istransmitted from the endoscope 10 to the processor device 30.

The processor device 30 processes the image signal obtained from theendoscope 10, and outputs the processed signal to the monitor 32.Consequently, the image of the inside of the body cavity observedthrough the observation window 14 of the endoscope 10 is displayed onthe monitor 32.

Note that the endoscope 10 of this example includes no illuminationmeans. Illumination is provided through another piece of means, forexample a needle light. Omission of the illumination means that is to beembedded in the endoscope allows the diameter of the insertion part ofthe endoscope to be narrowed. Consequently, the diameter of the outertube 100 can also be narrowed, and the invasiveness applied to a bodywall of the patient can be reduced.

The endoscope 10 of this example has the configuration including theimaging device 20 at the distal end part of the insertion part 12.Alternatively, a configuration that includes the imaging device 20 atthe proximal end part of the insertion part 12 may be adopted. That is,a configuration where an image observed through the observation window14 is transmitted by a relay lens and the like and taken by the imagingdevice provided at the proximal end part of the insertion part 12 may beadopted.

The endoscope 10 requires use of the outer tube 100 as a precondition.Consequently, the external shape of the endoscope is made suitable forthe structure of the outer tube 100. In particular, the endoscope 10 ofthis embodiment is configured to have an outer diameter with two steps,and the distal end part (the part (part having a second diameter A2) tobe delivered to protrude out of the outer tube 100) is narrowed so asnot to interfere with the treatment tool 60. This point will bedescribed later in detail.

<Needle Light>

FIG. 4 is a schematic configuration diagram showing an example of aneedle light.

The needle light 40 as a medical instrument is inserted into the bodycavity of the patient and illuminates the body cavity with illuminationlight.

The needle light 40 includes a linear-rod-shaped insertion part 42. Anillumination window (not shown) is provided at the distal end of theinsertion part 42. Through the illumination window, the illuminationlight is emitted in the axial direction. An optical fiber bundle thattransmits illumination light emitted from the illumination window iscontained inside the insertion part 42.

A connection part 44 is provided at the proximal end of the needle light40. A flexible cable 46 for the needle light is connected to theconnection part 44. A light source device 48 is connected through thiscable 46 for the needle light. The illumination light caused to beemitted through the illumination window is supplied from the lightsource device 48. The light source device 48 is connected to theprocessor device 30 through a cable. The light intensity and the likeare thus controlled.

As an example, the needle light 40 is inserted into the body cavitythrough an outer tube 50 for the needle light.

<Treatment Tool>

FIG. 5 is a schematic configuration diagram showing an example of thetreatment tool.

The treatment tool 60 as a medical instrument includes: alinear-rod-shaped insertion part 62 that is inserted into the bodycavity; a treatment part 64 that is arranged at the proximal end of theinsertion part 62; and a handle part (operation part) 66 that isarranged at the distal end of the insertion part 62. The treatment part64 shown in FIG. 5 has a structure of scissors. The treatment part 64 isoperated to open and close by an open and close operation of the handlepart 66.

Note that the treatment tool 60 is not limited to this example.Alternatively, forceps, a laser probe, a suture instrument, an electricscalpel, a needle holder, an ultrasonic aspirator or the like may beused as the treatment tool.

<Outer Tube>

The body cavity wall of the patient is punctured with the outer tube100. The endoscope 10 and the treatment tool 60 are inserted along theinner circumference part of the outer tube, which allows the endoscope10 and the treatment tool 60 to be guided into the body cavity of thepatient.

FIG. 6 is a side sectional view of the outer tube. FIG. 7 is a frontview of the outer tube. FIG. 8 is a rear view of the outer tube. FIG. 9is an enlarged sectional view of a proximal end part of the outer tube.FIG. 10 is an enlarged sectional view of a distal end part of the outertube. FIG. 11 is a sectional view taken along 11-11 of FIG. 9.

The outer tube 100 includes a cylindrical outer tube body 102. The outertube body 102 has a cylindrical shape, and the proximal end part isformed to have a flange shape with an enlarged diameter.

A proximal end cap 104 is attached to the proximal end part of the outertube body 102. An opening part of the outer tube body 102 at theproximal end is blocked with the proximal end cap 104. A distal end cap106 is attached to the distal end part of the outer tube body 102. Anopening part of the outer tube body 102 at the distal end is blockedwith the distal end cap 106.

As shown in FIG. 8, the proximal end cap 104 is provided with anendoscope entry port 110 as a first entry port for allowing theinsertion part 12 of the endoscope 10 to be inserted into the outer tubebody 102, and a treatment tool entry port 108 as a second entry port forallowing the insertion part 62 of the treatment tool 60 to be insertedinto the outer tube body 102.

The treatment tool entry port 108 has a circular shape, and is formed tohave a size allowing the insertion part 62 of the treatment tool 60 tobe inserted through the port. That is, the port is formed to have a sizewhich makes the thickest portion of the insertion part 62 of thetreatment tool 60 to be inserted into the outer tube 100 insertable intothe port.

The endoscope entry port 110 has a circular shape, and is formed to havea size allowing the insertion part 12 of the endoscope 10 to be insertedthrough the port. That is, the port is formed to have a size which makesthe thickest portion of the insertion part 12 of the endoscope 10 to beinserted into the outer tube 100 insertable into the port.

As shown in FIG. 6, the distal end cap 106 is provided with an endoscopeexit port 116 as a first exit port from which the insertion part 12 ofthe endoscope 10 inserted from the endoscope entry port 110 into theouter tube body 102 is delivered to protrude, and a treatment tool exitport 114 as a second exit port from which the insertion part 62 of thetreatment tool 60 inserted into the outer tube body 102 is delivered toprotrude.

The treatment tool exit port 114 has a circular shape, and is formed tohave a size allowing the distal end part of the insertion part 62 of thetreatment tool 60 to be inserted into the port. Preferably, thetreatment tool exit port 114 has a diameter substantially identical tothe outer diameter of the distal end part of the insertion part 62 ofthe treatment tool 60.

The endoscope exit port 116 has a circular shape in conformity with thedistal end part of the insertion part 12 of the endoscope 10, and isformed to have a size allowing the distal end part of the insertion part12 of the endoscope 10 to be inserted into the port. In particular, inthe outer tube 100 of this embodiment, the endoscope exit port 116 hasan inner diameter that is substantially identical to an outer diameterof the distal end part of the insertion part 12 of the endoscope 10, andis configured to allow the distal end part of the insertion part 12 ofthe endoscope 10 to be inserted with substantially no gap.

Here, as described above, in the endoscope 10 of this embodiment, thedistal end part of the insertion part 12 is narrowed. This configurationis for preventing the part from interfering with the treatment tool 60when the part is delivered to protrude out of the endoscope exit port116. Thus, in the endoscope 10, at least the part to be delivered toprotrude out of the endoscope exit port 116 (the part having the seconddiameter A2) is narrowed.

The endoscope exit port 116 is formed in conformity with the outerdiameter of the narrowed distal end part of the insertion part 12 of theendoscope 10. That is, the endoscope exit port 116 is configured so thatthe narrowed distal end part is insertable thereinto with substantiallyno gap. Consequently, the inner diameter ID0 of the endoscope exit port116 is formed to be slightly larger than the outer diameter OD0 (seconddiameter A2) of the distal end part (the part (the part having thesecond diameter A2) to be delivered to protrude out of the endoscopeexit port 116) of the insertion part 12 of the endoscope 10.

The treatment tool entry port 108 and the treatment tool exit port 114are coaxially arranged, and arranged on an axis parallel to the axis ofthe outer tube body 102. Consequently, the treatment tool 60 insertedthrough the treatment tool entry port 108 is delivered along the axis ofthe outer tube body 102 and protrudes out of the treatment tool exitport 114.

The endoscope entry port 110 and the endoscope exit port 116 arecoaxially arranged, and arranged on an axis parallel to the axis of theouter tube body 102. Consequently, the endoscope 10 inserted through theendoscope entry port 110 is delivered along the axis of the outer tubebody 102 and protrudes out of the endoscope exit port 116.

The proximal end cap 104 is provided with a valve member 120. The valvemember 120 seals the treatment tool entry port 108 and the endoscopeentry port 110.

FIG. 12 is an exploded perspective view showing a schematicconfiguration of the valve member. FIG. 13 is a side sectional view ofthe valve member.

The valve member 120 is configured to include a first valve body 122, anintermediate member 124, and a second valve body 126.

The first valve body 122, the intermediate member 124 and the secondvalve body 126 are circular plate members (disk-shaped members) havingthe same outer diameter, and coaxially overlaid so as to be integrated,thus configuring the valve member 120.

The first valve body 122 and the second valve body 126 are made of anelastic material, such as natural rubber, synthetic rubber, or siliconerubber, and formed to be elastically deformable.

The intermediate member 124 is made of a material having stiffness,which is metal, such as stainless steel or aluminum, or rigid plastic orthe like. The intermediate member 124 plays a role of reinforcing thefirst valve body 122 and the second valve body 126 which are overlaid onthe front and rear of this member 124.

The intermediate member 124 has a treatment tool insertion hole 128 intowhich the insertion part 62 of the treatment tool 60 is inserted, and anendoscope insertion hole 130 into which the insertion part 12 of theendoscope 10 is inserted.

The treatment tool insertion hole 128 has a circular shape, and isformed to have a size allowing the insertion part 62 of the treatmenttool 60 to be inserted into this hole. That is, this hole is formed tohave a size which makes the thickest portion of the insertion part 62 ofthe treatment tool 60 to be inserted into the outer tube 100 insertableinto the port.

The endoscope insertion hole 130 has a circular shape, is formed to havea size allowing the insertion part 12 of the endoscope 10 to be insertedinto this hole. That is, this hole is formed to have a size which makesthe thickest portion of the insertion part 12 of the endoscope 10 to beinserted into the outer tube 100 insertable into the port.

The treatment tool insertion hole 128 is arranged coaxially with thetreatment tool entry port 108. The endoscope insertion hole 130 isarranged coaxially with the endoscope entry port 110. Consequently, whenthe insertion part 62 of the treatment tool 60 is inserted through thetreatment tool entry port 108, the insertion part 62 of the treatmenttool 60 is, in turn, inserted into the treatment tool insertion hole128. When the insertion part 12 of the endoscope 10 is inserted throughthe endoscope entry port 110, the insertion part 12 of the endoscope 10is, in turn, inserted into the endoscope insertion hole 130.

The first valve body 122 arranged on the proximal end side is providedwith an opening type hermetic valve part 132 for the treatment tool, anda slit type hermetic valve part 134 for the endoscope.

The opening type hermetic valve part 132 for the treatment tool isformed as a circular opening in the first valve body 122. The openingtype hermetic valve part 132 for the treatment tool functions as asealing member (treatment tool sealing member) that seals a gap formedbetween the insertion part 62 of the treatment tool 60 and the treatmenttool entry port 108 when the insertion part 62 of the treatment tool 60is inserted into the outer tube 100. The opening type hermetic valvepart 132 for the treatment tool is arranged coaxially with the treatmenttool insertion hole 128. This portion is formed to have an innerdiameter ID1 that is slightly smaller than the outer diameter (the outerdiameter of a part in contact with the opening type hermetic valve part132 for the treatment tool) OD1 of the insertion part 62 of thetreatment tool 60. Consequently, when the insertion part 62 of thetreatment tool 60 is fitted into the opening type hermetic valve part132 for the treatment tool, the inner peripheral surface of the openingis brought into close contact with the outer peripheral surface of theinsertion part 62 of the treatment tool 60. Consequently, when theinsertion part 62 of the treatment tool 60 is inserted into the outertube 100, the gap formed between the insertion part 62 of the treatmenttool 60 and the treatment tool entry port 108 is sealed.

The slit type hermetic valve part 134 for the endoscope is formed as asingle linear slit with a predetermined length in the first valve body122. After the insertion part 12 of the endoscope 10 is extracted out ofthe outer tube 100, the slit type hermetic valve part 134 for theendoscope blocks the endoscope entry port 110.

The second valve body 126, which is arranged on the distal end side, isprovided with an opening type hermetic valve part 138 for the endoscope,and a slit type hermetic valve part 136 for the treatment tool.

The opening type hermetic valve part 138 for the endoscope is formed asa circular opening in the second valve body 126. When the insertion part12 of the endoscope 10 is inserted into the outer tube 100, the openingtype hermetic valve part 138 for the endoscope functions as a sealingmember (endoscope sealing member) that seals the gap formed between theinsertion part 12 of the endoscope 10 and the endoscope entry port 110.The opening type hermetic valve part 138 for the endoscope is arrangedcoaxially with the endoscope insertion hole 130. This opening typehermetic valve part 138 is formed to have an inner diameter ID2 that isslightly smaller than the outer diameter OD2 of the insertion part 12 ofthe endoscope 10. Consequently, when the insertion part 12 of theendoscope 10 is fitted into the opening type hermetic valve part 138 forthe endoscope, the inner peripheral surface of the opening is broughtinto close contact with the outer peripheral surface of the insertionpart 12 of the endoscope 10. Consequently, when the insertion part 12 ofthe endoscope 10 is inserted into the outer tube 100, the gap formedbetween the insertion part 12 of the endoscope 10 and the endoscopeentry port 110 is sealed.

The slit type hermetic valve part 136 for the treatment tool is formedas a single linear slit with a predetermined length in the second valvebody 126. After the insertion part 62 of the treatment tool 60 isextracted out of the outer tube 100, the slit type hermetic valve part136 for the treatment tool, which is formed as the slit, blocks thetreatment tool entry port 108.

According to the valve member 120 configured as described above, afterthe insertion part 62 of the treatment tool 60 and the insertion part 12of the endoscope 10 are inserted into the outer tube 100, thehermeticity of the outer tube 100 is secured by the opening typehermetic valve part 132 for the treatment tool and the opening typehermetic valve part 138 for the endoscope. When the insertion part 62 ofthe treatment tool 60 and the insertion part 12 of the endoscope 10 arenot inserted into the outer tube 100, the hermeticity of the outer tube100 is secured by the slit type hermetic valve part 136 for thetreatment tool and the slit type hermetic valve part 134 for theendoscope.

Inside the outer tube body 102, a slider (movable object) 140 that ismovable in a direction parallel to the axis of the outer tube body 102is provided.

The slider 140 is configured as a block that is movable in the outertube body 102. In this embodiment, the slider is configured as acylindrical block.

The slider 140 is configured to be movable inside the outer tube body102 along the axis of the outer tube body 102 guided by a pair of sliderguide shafts 142. The slider guide shafts 142 are each formed into alinear rod shape, and are arranged parallel to each other along the axisof the outer tube body 102. The slider guide shafts 142 are eachsupported by the proximal end cap 104 at the proximal end, and supportedby the distal end cap 106 at the distal end, and are arranged inparallel to the axis of the outer tube body 102.

The slider 140 is provided with a pair of slider guide holes 144 intowhich the pair of slider guide shafts 142 can be inserted. In the pairof slider guide holes 144, the slider guide holes 144 are arranged sothat the interval therebetween becomes the same as the arrangementinterval of the pair of slider guide shafts 142, and are arranged inparallel to each other. The slider guide shafts 142 are inserted intothe respective slider guide holes 144, thereby allowing the slider 140to be slidably supported by the slider guide shafts 142.

The slider 140 is provided with an endoscope holding part (first holdingpart) 148 that holds the insertion part 12 of the endoscope 10 insertedinto the outer tube body 102, and a treatment tool holding part (secondholding part) 146 that holds the insertion part 62 of the treatment tool60 inserted into the outer tube body 102.

The treatment tool holding part 146 includes a treatment tool holdinghole 150 through which the insertion part 62 of the treatment tool 60 isinserted, and a cylindrical (annular) elastic member 152 that isarranged in the treatment tool holding hole 150.

The treatment tool holding hole 150 is formed to penetrate through theslider 140, and formed in parallel to the axis of the outer tube body102. The treatment tool holding hole 150 is provided for the slider 140so as to be arranged coaxially with the treatment tool entry port 108and the treatment tool exit port 114.

The cylindrical elastic member 152 is coaxially fixed and attached tothe inner circumference part of the treatment tool holding hole 150. Thecylindrical elastic member 152 is formed to have an inner diameter ID3that is slightly smaller than the outer diameter (the outer diameter ofa part held by the treatment tool holding part 146) OD3 of the insertionpart 62 of the treatment tool 60.

In the treatment tool 60 of this embodiment, the insertion part 62 hasthe constant outer diameter. Consequently, the outer diameter OD3 of thepart held by the treatment tool holding part 146 is the same as theouter diameter OD1 of the part which is in contact with the opening typehermetic valve part 132 for the treatment tool (OD1=OD3). Accordingly,the inner diameter ID3 of the elastic member 152 is identical to orsubstantially identical to the inner diameter ID1 of the opening typehermetic valve part 132 for the treatment tool (ID1=ID3).

The insertion part 62 of the treatment tool 60, which is inserted fromthe treatment tool entry port 108 into the outer tube body 102, passesthrough the treatment tool holding hole 150 and is delivered to protrudeout of the treatment tool exit port 114. When the insertion part 62 ofthe treatment tool 60 passes through the treatment tool holding hole150, this part passes through the elastic member 152. As describedabove, the elastic member 152 is formed to have the inner diameter thatis slightly smaller than the outer diameter (the outer diameter of thepart held by the treatment tool holding part 146) of the insertion part62 of the treatment tool 60. Consequently, when the insertion part 62 ofthe treatment tool 60 passes through the treatment tool holding hole150, this part is held by the treatment tool holding hole 150 by meansof the elastic force of the elastic member 152.

Note that the portion is thus held by means of the elastic force of theelastic member 152. Consequently, the holding position of the treatmenttool 60 can be arbitrarily adjusted with respect to the slider 140.

The treatment tool 60 is held by the elastic force of the elastic member152. However, the frictional force between the elastic member 152 andthe insertion part 62 of the treatment tool 60 is configured to behigher than the frictional force between the slider guide shaft 142 andthe slider guide hole 144 (=the frictional force between the outer tubebody 102 and the slider 140). Consequently, when the treatment tool 60is moved in the axial direction, the slider 140 and the treatment tool60 are integrally moved with respect to the outer tube body 102.

The endoscope holding part 148 includes an endoscope holding hole 154through which the insertion part 12 of the endoscope 10 is inserted, anda cylindrical (annular) elastic member 156 that is arranged in theendoscope holding hole 154.

The endoscope holding hole 154 is formed to penetrate through the slider140, and formed in parallel to the axis of the outer tube body 102. Theendoscope holding hole 154 is provided for the slider 140 so as to bearranged coaxially with the endoscope entry port 110 and the endoscopeexit port 116.

The cylindrical elastic member 156 is coaxially fixed and attached tothe inner circumference part of the endoscope holding hole 154. Thecylindrical elastic member 156 is formed to have an inner diameter ID4that is slightly smaller than the outer diameter OD4 of the insertionpart 12 of the endoscope 10.

Note that the outer diameter OD4 (first diameter A1) of the insertionpart 12 of the endoscope 10 is the outer diameter of the part having anenlarged diameter on the proximal end part side. That is, the endoscope10 is held by the endoscope holding part 148 at the part having theenlarged diameter on the proximal end part side. Consequently, thestrength of the insertion part 12 of the endoscope 10 can be secured,and the durability can be improved.

The part (the part having the second diameter) (narrowed-diameter part)having a narrowed diameter of the endoscope 10 is a part to be deliveredto protrude out of the endoscope exit port 116 of the outer tube 100when the endoscope 10 is inserted into the outer tube 100 and used. Ifthe holding position of the endoscope 10 by means of the endoscopeholding part 148 is made adjustable, the narrowed-diameter part isconfigured in consideration of the adjustment margin.

As a result, the insertion part 12 of the endoscope 10 is configured tohave an external shape in which the distal end part has a narroweddiameter.

The outer tube 100 is configured in conformity with the external shapeof the insertion part 12 of the endoscope 10 such that the endoscopeexit port 116 is formed to have the inner diameter ID0 that is smallerthan the inner diameter ID4 of the annular elastic member 156 providedat the endoscope holding part 148.

In the endoscope 10 of this embodiment, only the distal end part of theinsertion part 12 is narrowed. Accordingly, the outer diameter OD4 ofthe part held by the endoscope holding part 148 is the same as the outerdiameter OD2 of the part to be in contact with the opening type hermeticvalve part 138 for the endoscope (OD2=OD4). Consequently, the innerdiameter ID4 of the elastic member 156 is also identical to orsubstantially identical to the inner diameter ID2 of the opening typehermetic valve part 138 for the endoscope.

The insertion part 12 of the endoscope 10 inserted from the endoscopeentry port 110 into the outer tube body 102 passes through the endoscopeholding hole 154, and is delivered to protrude out of the endoscope exitport 116. When the endoscope 10 passes through the endoscope holdinghole 154, this endoscope passes through the elastic member 156. Asdescribed above, the elastic member 156 is formed to have the innerdiameter that is slightly smaller than the outer diameter of theinsertion part 12 of the endoscope 10. Consequently, after the insertionpart 12 of the endoscope 10 passes through the endoscope holding hole154, the insertion part 12 is held by the endoscope holding hole 154 bymeans of the elastic force of the elastic member 156.

Note that the endoscope 10 is thus held by means of the elastic force ofthe elastic member 156. Consequently, the holding position of theendoscope 10 can be arbitrarily adjusted with respect to the slider 140.

The endoscope 10 is held by the elastic force of the elastic member 156.However, the frictional force between the elastic member 156 and theinsertion part 12 of the endoscope 10 is configured to be higher thanthe frictional force between the slider guide shaft 142 and the sliderguide hole 144 (=the frictional force between the outer tube body 102and the slider 140). Consequently, when the endoscope 10 is moved in theaxial direction, the slider 140 and the endoscope 10 are integrallymoved with respect to the outer tube body 102.

<<Operation of Endoscopic Surgical Device>>

First, the insertion part 12 of the endoscope 10 is inserted from theendoscope entry port 110. The insertion part 12 inserted into theendoscope entry port 110 passes through the outer tube body 102, anddelivered to protrude out of the endoscope exit port 116. In this case,the insertion part 12 passes through the endoscope holding hole 154provided in the slider 140 in the outer tube body 102, and is deliveredto protrude out of the endoscope exit port 116. The endoscope holdinghole 154 is provided with the elastic member 156. The insertion part 12passing through the endoscope holding hole 154 is held by the slider 140by means of the elastic force of the elastic member 156.

Next, the insertion part 62 of the treatment tool 60 is inserted fromthe treatment tool entry port 108. The insertion part 62 inserted intothe treatment tool entry port 108 passes through the outer tube body102, and is delivered to protrude out of the treatment tool exit port114. In this case, the insertion part 62 passes through the treatmenttool holding hole 150 provided in the slider 140 in the outer tube body102, and is delivered to protrude out of the treatment tool exit port114. The treatment tool holding hole 150 is provided with the elasticmember 152. The insertion part 62 passing through the treatment toolholding hole 150 is held by the slider 140 by means of the elastic forceof the elastic member 152.

Both the insertion part 12 of the endoscope 10 inserted into the outertube 100 and the insertion part 62 of the treatment tool 60 are held bythe slider 140. Consequently, when the treatment tool 60 is moved in theaxial direction, the endoscope 10 is moved in the axial direction ininterlock with the movement.

As described above, the endoscopic surgical device 1 of this embodimentcan move the endoscope 10 in interlock with the treatment tool 60.Consequently, the visual field (imaging region) of the endoscope 10 canbe caused to follow the treatment portion, and an image optimal totreatment can be always provided for the operator.

Note that the movement (to-and-fro movement) in the forward and reardirection of the endoscope visual field is performed by the movement inthe axial direction of the treatment tool 60. Meanwhile, the movement inthe vertical and horizontal directions is performed by the inclinationmovement of the treatment tool 60. That is, all the parts including theouter tube 100 are inclined to move the visual field.

Typically, laparoscopic surgery is performed by supplying gas into theabdominal cavity to expand the abdominal cavity. However, the outer tube100 is provided with the valve member 120. Consequently, the hermeticitycan be secured.

Furthermore, because the distal end part of the endoscope 10 that is tobe delivered to protrude out of the endoscope exit port 116 is narrowed,even if the outer tube 100 is narrowed, the endoscope can be usedwithout interference with the treatment tool 60. That is, in order toperform a low-invasive operation, the endoscope 10 and the treatmenttool 60 should be arranged as close as possible and the diameter of theouter tube 100 is required to be reduced. However, too close arrangementof both the elements causes situations where the visual field of theendoscope 10 is blocked by the treatment tool 60 and reduced, or thetreatment portion 64 of the treatment tool 60 is brought into contactwith the endoscope 10. However, as with this embodiment, the distancebetween the centers of axes of both the elements can be secured bynarrowing the diameter of the distal end of the endoscope 10.Consequently, reduction in the visual field of the endoscope 10 andcontact with the treatment portion 64 can be prevented.

On the other hand, reduction in the diameter of the insertion part 12 ofthe endoscope 10 reduces the strength of the insertion part 12. However,in this embodiment, only the distal end is narrowly formed, but theholding part (the part held by the endoscope holding part 148) thatrequires strength is formed to have a large diameter. Consequently,sufficient strength can be secured. Therefore, durability can besecured.

Since the endoscope 10 has the narrowed distal end part of the insertionpart 12, the sliding friction applied from the valve member 120 duringinsertion into and extraction from the outer tube 100 can be eliminatedat the distal end part. Accordingly, insertion and extraction can besmoothly performed without unnecessary force.

<<Example of Use of Endoscopic Surgical Device>>

FIG. 14 is a schematic diagram showing an example of an operation methodusing the endoscopic surgical device.

This example indicates an example of the case where a single operatorperforms treatment.

The endoscope 10 and the treatment tool 60 are inserted into the bodycavity 3 through the outer tube 100 that is punctured into the bodycavity wall 2 of the patient. The endoscope 10 moves in interlock withthe movement of the treatment tool 60. Consequently, the video image ofthe treatment portion is always displayed on the monitor 32, and themovement of the treatment tool 60 can, in turn, move the visual field.

The endoscope 10 is provided with no illumination means. Consequently,the needle light 40 is used as the illumination means. The needle light40 is inserted into the body cavity 3 through the outer tube 50 for theneedle light. The body cavity 3 is illuminated with illumination lightemitted from the distal end of the needle light 40. This exampleexemplifies the case of using the single needle light 40. Alternatively,multiple needle lights 40 may be used as necessary.

According to the endoscopic surgical device 1 of this embodiment, theoperation of the treatment tool 60 also operates the endoscope 10.Consequently, treatment can be performed by a single operator. That is,laparoscopist is unnecessary.

Furthermore, the endoscope 10 and the treatment tool 60 are insertedinto the body cavity 3 through the outer tube 100. Consequently, onlyone site to be punctured is required to allow the endoscope 10 and thetreatment tool 60 to be inserted into the body cavity. Therefore, alow-invasive operation can be performed.

<<Second Embodiment of Outer Tube>>

FIG. 15 is a side sectional view of an outer tube of a secondembodiment. FIG. 16 is an enlarged sectional view of a proximal end partof the outer tube of the second embodiment. FIG. 17 is a sectional viewtaken along 17-17 of FIG. 16.

The outer tube 200 of this embodiment is different from the outer tube100 of the embodiment described above in that a slider 210 arrangedinside an outer tube body includes a movable part. Except for thedifference in the configuration of the slider 210, the configuration isthe same as the configuration of the outer tube 100 of the embodimentdescribed above. Consequently, only the configuration of the slider 210is herein described (the same signs are assigned to otherconfigurations, and the explanation about them is omitted).

<Configuration>

The slider 210 is configured to include a slider body (movable objectmain body) 212, and a sleeve (movable part) 214 that is configured to bemovable in the axial direction with respect to the slider body.

The slider body 212 is configured as a block that is movable in theouter tube body 102. In this embodiment, this body is configured as acylindrical block.

The slider body 212 is configured to be movable inside the outer tubebody 102 along the axis of the outer tube body 102 guided by the pair ofslider guide shafts 142. The slider body 212 is provided with a pair ofslider guide holes 216 through which the pair of slider guide shafts 142can be inserted. The pair of slider guide holes 216 is arranged so thatthe interval between the slider guide holes 216 is the same as thearrangement interval of the pair of slider guide shafts 142, and theslider guide holes 216 are arranged parallel to each other. The sliderguide shafts 142 are inserted into the respective slider guide holes216, thereby allowing the slider body 212 to be slidably supported bythe slider guide shafts 142.

The slider body 212 is provided with a sleeve guide hole 218. The sleeveguide hole 218 is formed to be a hole having as a round-shapedcross-section and to penetrate through the slider body 212. The sleeveguide hole 218 is formed in parallel to the axis of the outer tube body102, and provided for the slider body 212 so as to be arranged coaxiallywith the treatment tool entry port 108 and the treatment tool exit port114.

The sleeve 214 is formed to have a shape (a cylindrical body in thisexample) that is slidable in the sleeve guide hole 218. The sleeve 214is contained in the sleeve guide hole 218, and arranged movable in thesleeve guide hole 218. In the sleeve guide hole 218, stopper parts 220for restricting the movement of the sleeve 214 are provided at both theends thereof so as to protrude in radial directions. The movable rangeof the sleeve 214 is restricted by the stopper parts 220. Furthermore,the sleeve 214 is prevented from dropping off the sleeve guide hole 218by the stopper parts 220.

The slider 210 is provided with a treatment tool holding part 222 thatholds the insertion part 62 of the treatment tool 60 inserted into theouter tube body 102, and an endoscope holding part 224 that holds theinsertion part 12 of the endoscope 10 inserted into the outer tube body102. The treatment tool holding part 222 is provided in the sleeve 214.The endoscope holding part 224 is provided in the slider body 212.

The treatment tool holding part 222 includes a treatment tool holdinghole 226 through which the insertion part 62 of the treatment tool 60 isinserted, and a cylindrical (annular) elastic member 228 arranged in thetreatment tool holding hole 226.

The treatment tool holding hole 226 is configured by the innercircumference part of the sleeve 214, which is configured to be acylindrical body. As described above, the sleeve guide hole 218 thatguides the sleeve 214 is formed in parallel to the axis of the outertube body 102, and arranged coaxially with the treatment tool entry port108 and the treatment tool exit port 114. Consequently, the treatmenttool holding hole 226, which is the inner circumference part of thesleeve 214, is also arranged in parallel to the axis of the outer tubebody 102, and arranged coaxially with the treatment tool entry port 108and the treatment tool exit port 114.

The cylindrical elastic member 228 is coaxially fixed and attached tothe inner circumference part of the treatment tool holding hole 226. Thecylindrical elastic member 228 is formed to have the inner diameter ID3that is slightly smaller than the outer diameter (the outer diameter ofthe part held by treatment tool holding part 222) OD3 of the insertionpart 62 of the treatment tool 60.

The insertion part 62 of the treatment tool 60 inserted from thetreatment tool entry port 108 into the outer tube body 102 passesthrough the treatment tool holding hole 226, and is delivered toprotrude out of the treatment tool exit port 114. When the insertionpart 62 of the treatment tool 60 passes through the treatment toolholding hole 226, this part passes through the elastic member 228. Asdescribed above, the elastic member 228 is formed to have the innerdiameter that is slightly smaller than the outer diameter (the outerdiameter of the part held by the treatment tool holding part 222) of theinsertion part 62 of the treatment tool 60. Consequently, after theinsertion part 62 of the treatment tool 60 passes through the treatmenttool holding hole 226, this part is held by the treatment tool holdinghole 226 by means of the elastic force of the elastic member 228.

Note that the portion is thus held by means of the elastic force of theelastic member 228. Consequently, the holding position of the treatmenttool 60 can be arbitrarily adjusted with respect to the sleeve 214.

The endoscope holding part 224 includes an endoscope holding hole 230through which the insertion part 12 of the endoscope 10 is inserted, anda cylindrical (annular) elastic member 232 arranged in the endoscopeholding hole 230.

The endoscope holding hole 230 is formed to penetrate through the sliderbody 212, and formed in parallel to the axis of the outer tube body 102.The endoscope holding hole 230 is provided for the slider body 212 so asto be arranged coaxially with the endoscope entry port 110 and theendoscope exit port 116.

The cylindrical elastic member 232 is coaxially fixed and attached tothe inner circumference part of the endoscope holding hole 230. Thecylindrical elastic member 232 is formed to have the inner diameter ID4that is slightly smaller than the outer diameter OD4 of the insertionpart 12 of the endoscope 10.

Here, the outer diameter OD4 of the insertion part 12 of the endoscope10 is the outer diameter of the part having the enlarged diameter on theproximal end part side. That is, the endoscope 10 is held by theendoscope holding part 224 at the part having the enlarged diameter onthe proximal end part side.

The insertion part 12 of the endoscope 10 inserted from the endoscopeentry port 110 into the outer tube body 102 passes through the endoscopeholding hole 230, and is delivered to protrude out of the endoscope exitport 116. When the endoscope 10 passes through the endoscope holdinghole 230, the endoscope 10 passes through the elastic member 232. Asdescribed above, the elastic member 232 is formed to have the innerdiameter that is slightly smaller than the outer diameter of theinsertion part 12 of the endoscope 10. Consequently, after the insertionpart 12 of the endoscope 10 passes through the endoscope holding hole230, this part is held by the endoscope holding hole 230 by means of theelastic force of the elastic member 232.

Note that the part is thus held by means of the elastic force of theelastic member 232. Consequently, the holding position of the endoscope10 can be arbitrarily adjusted with respect to the slider body 212.

The outer tube 200 of this embodiment is configured as described above.

<Operation>

First, the insertion part 12 of the endoscope 10 is inserted from theendoscope entry port 110. The insertion part 12 inserted into theendoscope entry port 110 passes through the outer tube body 102, and isdelivered to protrude out of the endoscope exit port 116. In this case,the insertion part 12 passes through the endoscope holding hole 230provided in the slider 210 in the outer tube body 102, and is deliveredto protrude out of the endoscope exit port 116. The endoscope holdinghole 230 is provided with the elastic member 232. The insertion part 12passing through the endoscope holding hole 230 is held by the sliderbody 212 by means of the elastic force of the elastic member 232.

Next, the insertion part 62 of the treatment tool 60 is inserted fromthe treatment tool entry port 108. The insertion part 62 inserted intothe treatment tool entry port 108 passes through the outer tube body102, and is delivered to protrude out of the treatment tool exit port114. In this case, the insertion part 62 passes through the innercircumference part (treatment tool holding hole 226) of the sleeve 214provided in the slider 210 in the outer tube body 102, and is deliveredto protrude out of the treatment tool exit port 114. The innercircumference part (treatment tool holding hole 226) of the sleeve 214is provided with the elastic member 228. The insertion part 62 passingthrough the inner circumference part (treatment tool holding hole 226)of the sleeve 214 is held by the sleeve 214 by means of the elasticforce of the elastic member 228.

After the insertion part 12 of the endoscope 10 and the insertion part62 of the treatment tool 60 are thus inserted into the outer tube 200,the insertion part 12 of the endoscope 10 and the insertion part 62 ofthe treatment tool 60 are connected by the slider 210. As a result, whenthe treatment tool 60 is moved in the axial direction, the endoscope 10is moved in the axial direction in interlock with the movement.

Here, the sleeve 214 for holding the treatment tool 60 is configured tobe movable in the axial direction with respect to the slider body 212for holding the endoscope 10. As a result, only when the treatment tool60 is moved by a predetermined amount or more, the endoscope 10 moves ininterlock with the treatment tool 60. That is, even when the treatmenttool 60 is moved, if the movement of the tool is within the movablerange of the sleeve 214, the endoscope is not moved and its stationarystate is maintained. On the other hand, when the treatment tool 60 ismoved exceeding the movable range of the sleeve 214, the endoscope 10 ismoved in interlock with the movement of the treatment tool 60. That is,the interlocked movement is not caused by minute and small movement.Instead, the interlocked movement is caused only by large movement.

The movable range of the treatment tool 60 is restricted by the stopperparts 220 at both the ends of the sleeve guide hole 218. Consequently,when the sleeve 214 abuts on the stopper part 220, the treatment tool 60and the endoscope 10 move in interlock with each other.

Thus, the outer tube 200 of this embodiment thus has what is so-called aplay (non-sensitive region) for the movement of the treatment tool 60,and is configured so as not to transmit small movement to the endoscope10. Consequently, even when the insertion part 62 of the treatment tool60 is minutely displaced in the axial direction (the case of performingto-and-fro movement with a small amplitude), the image on the screen canbe prevented from swaying (a stable image can be provided).

If the frictional force between the sleeve 214 and the sleeve guide hole218 is greater than the frictional force between the slider guide shaft142 and the slider guide hole 216 (=the frictional force between theouter tube body 102 and the slider body 212), the entire slider body 212is moved by movement of the treatment tool 60 (the sleeve 214 does notslide against the slider body 212, but the entire slider body 212moves). Thus, the slider 210 is configured to have the frictional forcebetween the sleeve 214 and the sleeve guide hole 218 that is smallerthan the frictional force between the slider guide shaft 142 and theslider guide hole 216.

The treatment tool 60 is held by the treatment tool holding part 222 bymeans of the elastic force of the elastic member 228. However, thefrictional force between the elastic member 228 and the insertion part62 of the treatment tool 60 is configured to be greater than thefrictional force between the sleeve 214 and the sleeve guide hole 218and the frictional force between the slider guide shaft 142 and theslider guide hole 216 (=the frictional force between the outer tube body102 and the slider body 212).

Likewise, the endoscope 10 is held by the endoscope holding part 224 bymeans of the elastic force of the elastic member 232. However, thefrictional force between the elastic member 232 and the insertion part62 of the treatment tool 60 is configured to be greater than thefrictional force between the sleeve 214 and the sleeve guide hole 218and the frictional force between the slider guide shaft 142 and theslider guide hole 216 (=the frictional force between the outer tube body102 and the slider body 212).

<<Other Embodiments of Outer Tube>>

The outer tube 200 of the second embodiment has the configuration wherethe movable part (sleeve 214) of the slider 210 is provided with thetreatment tool holding part 222, and the slider body 212 is providedwith the endoscope holding part 224. Alternatively, as shown in FIG. 18,the movable part (sleeve 214) of the slider 210 may be provided with theendoscope holding part 224, and the slider body 212 may be provided withthe treatment tool holding part 222. In this case, the treatment toolholding hole 226 is formed in the slider body 212, and the innercircumference part of the sleeve 214 serves as the endoscope holdinghole 230. Also with such a configuration, the treatment tool 60 and theendoscope 10 can move in interlock with each other, and minutevibrations are prevented from being transmitted.

In the above embodiment, only for the endoscope, the diameter of thedistal end part (the part to be delivered to protrude out of theendoscope exit port 116) is narrowed (for the outer tubes 100 and 200,the inner diameters ID0 of the endoscope exit ports 116 are configuredsmaller than the inner diameters ID4 of the elastic members 156 and232). Likewise, also for the treatment tool, the diameter of the distalend part (the part to be delivered to protrude out of the treatment toolexit port 114) may be narrowed.

In this case, as shown in FIG. 19, the outer tube 200 is configured tohave the inner diameter ID0 of the treatment tool exit port 114 that issmaller than the inner diameter ID3 of the elastic member 228.

On the other hand, the treatment tool 60 is formed such that the part tobe delivered to protrude out of the treatment tool exit port 114 has theouter diameter (second diameter B2) that is smaller than the outerdiameter (first diameter B1) of the part to be held by the treatmenttool holding part 222. That is, the distal end part side is narrowlyformed. Consequently, also for the treatment tool 60, the strength as awhole can be secured while the diameter of the required part facilitatedto be narrowed.

Here, for both the endoscope and the treatment tool, their distal endparts may have narrowed diameters. Alternatively, for only one of theendoscope and the treatment tool, the distal end part may have anarrowed diameter.

In the above embodiment, the outer diameter of the endoscope has atwo-step configuration and the diameter of the distal end part isnarrowed. Any configuration may be sufficient so long as a part to bedelivered to protrude out of the endoscope exit port 116 is formed inconformity with the inner diameter of the endoscope exit port 116, and apart to be held by the endoscope holding part 148 or 224 is formed tohave a diameter that can be held by the endoscope holding part 148 or224.

Accordingly, for example, as shown in FIG. 20, the part to be broughtinto contact with the opening type hermetic valve part 138 for theendoscope (the portion of the third diameter A3) may be formed to havethe outer diameter OD2 (third diameter A3) that is smaller than theouter diameter OD4 (first diameter A1) of the part to be held by theendoscope holding part 148 (the portion of the first diameter A1).Therefore, when the endoscope 10 is moved in the axial direction, thesliding friction applied to the opening type hermetic valve part 138 forthe endoscope can be reduced. Consequently, the force required when thetreatment tool 60 and the endoscope 10 are moved in the axial directioncan be reduced. Furthermore, the movement of the treatment tool 60 andthe endoscope 10 in the axial direction can be smoothed. Note that inthis case, the opening type hermetic valve part 138 for the endoscope ofthe outer tube 100 is formed to have the inner diameter ID2 that issmaller than the inner diameter ID4 of the elastic member 156 inconformity with the endoscope 10.

Likewise, also for the treatment tool 60, the part to be brought intocontact with the opening type hermetic valve part 132 for the treatmenttool may be formed to have the outer diameter (third diameter B3) thatis smaller than the outer diameter (first diameter B1) of the part to beheld by the treatment tool holding part 146.

Furthermore, for example, as shown in FIG. 21, the part to be broughtinto contact with the opening type hermetic valve part 138 for theendoscope (the portion of the third diameter A3) may be formed to havethe outer diameter OD2 (third diameter A3) that is larger than the outerdiameter OD4 (first diameter A1) of the part to be held by the endoscopeholding part 148 (the portion of the first diameter A1). Consequently,the sliding friction applied to the endoscope by the opening typehermetic valve part 138 during insertion and extraction of the endoscope10 can be reduced, and the insertion and extraction operation of theendoscope 10 can be smoothly performed without unnecessary force. Notethat in this case, the opening type hermetic valve part 138 for theendoscope of the outer tube 100 is formed to have the inner diameter ID2that is larger than the inner diameter ID4 of the elastic member 156 inconformity with the endoscope 10.

Likewise, also for the treatment tool 60, the part to be brought intocontact with the opening type hermetic valve part 132 for the treatmenttool may be formed to have the outer diameter (third diameter B3) thatis larger than the outer diameter (first diameter B1) of the part to beheld by the treatment tool holding part 146.

In the above embodiments, in the case of varying the diameter of theinsertion part of the endoscope 10, the variation is stepwisely made. Itis, however, preferable that the outer diameter be smoothly varied. Forexample, it is preferable the variation be performed in a taperedmanner, or in a curved manner as shown in FIG. 22. Consequently, duringinsertion and extraction of the endoscope 10, the part with a varyingdiameter can be prevented from being caught by the valve member 120 orthe like, and insertion and extraction operation can be furthersmoothed. The load onto the valve member 120 can be further reduced,thereby facilitating increase in the life-span of the valve member 120.

In the above embodiments, in the endoscope holding part, the member forholding the endoscope is the cylindrical elastic member. However, in theendoscope holding part, the member for holding the endoscope is notlimited to the case. Alternatively, for example, a configuration where aring-shaped elastic member, such as an O-ring, is used to hold theendoscope may be adopted. In this case, a configuration where multiplering-shaped elastic members are coaxially arranged to hold the endoscopemay be adopted. This configuration is also applicable to the treatmenttool holding part. The configuration where a ring-shaped elastic member,such as an O-ring, is used to hold the treatment tool may be adopted.

APPENDIX

(A1) The surgical device, wherein the endoscope internally includes animaging device at a distal end of the insertion part.

(A2) The surgical device, wherein the first medical instrument is atreatment tool.

(A3) The surgical device, wherein the first holding part can adjust aholding position of the insertion part of the first medical instrument.

(A4) The surgical device, wherein the second holding part can adjust aholding position of the insertion part of the second medical instrument.

(A5) The surgical device, wherein the movable object main body isconfigured to have a greater movement resistance to the outer tube bodythan a movement resistance of the movable part to the movable objectmain body.

(B1) The outer tube wherein the first medical instrument is anendoscope.

(B2) The outer tube, wherein the endoscope internally includes animaging device at a distal end of the insertion part.

(B3) The outer tube, wherein the first medical instrument is a treatmenttool.

(B4) The outer tube, wherein the first holding part can adjust a holdingposition of the insertion part of the first medical instrument.

(B5) The outer tube, wherein the second holding part can adjust aholding position of the insertion part of the second medical instrument.

(B6) The outer tube, wherein

the first holding part includes an annular elastic member through whichthe insertion part of the first medical instrument is inserted, andwhich is configured to hold the insertion part of the first medicalinstrument by means of an elastic force, and

the first exit port has an inner diameter smaller than an inner diameterof the elastic member.

(B7) The outer tube, wherein the movable object main body is configuredto have a greater movement resistance to the outer tube body than amovement resistance of the movable part to the movable object main body.

(C1) The endoscope, wherein the endoscope internally includes an imagingdevice at a distal end of the insertion part.

(D1) The treatment tool, wherein

the outer tube further includes a treatment tool sealing member which isprovided at the treatment tool entry port, and is configured to slidablyseal the insertion part of the treatment tool, and

the insertion part of the treatment tool further includes a part whichis disposed closer to a proximal end than the part having the firstdiameter B1, and is configured to maintain hermeticity with thetreatment tool sealing member, and has a third diameter B3 smaller thanthe first diameter B1.

(D2) The treatment tool, wherein

the outer tube further includes a treatment tool sealing member which isprovided at the treatment tool entry port, and is configured to slidablyseal the insertion part of the treatment tool, and

the insertion part of the treatment tool further includes a part whichis disposed closer to proximal end than the part having the firstdiameter B1, and is configured to maintain hermeticity with thetreatment tool sealing member, and has a third diameter B3 larger thanthe first diameter B1.

What is claimed is:
 1. A surgical device comprising: a first medicalinstrument that includes an insertion part; a second medical instrumentthat includes an insertion part; and an outer tube into which theinsertion part of the first medical instrument and the insertion part ofthe second medical instrument are inserted, and is configured to guidethe insertion part of the first medical instrument and the insertionpart of the second medical instrument into a body cavity, wherein theouter tube comprises: a cylindrical outer tube body into which theinsertion part of the first medical instrument and the insertion part ofthe second medical instrument are inserted; a first entry port providedat a proximal end part of the outer tube body; a second entry portprovided at the proximal end part of the outer tube body; a first exitport provided at a distal end part of the outer tube body; a second exitport provided at the distal end part of the outer tube body; a movableobject which is arranged in the outer tube body and is configured to bemovable in the outer tube body in an axial direction; a first holdingpart which is provided at the movable object and configured to hold theinsertion part of the first medical instrument inserted into the outertube body; and a second holding part which is provided at the movableobject and configured to hold the insertion part of the second medicalinstrument inserted into the outer tube body, wherein the first holdingpart includes a first annular elastic member through which the insertionpart of the first medical instrument is inserted, and the second holdingpart includes a second annular elastic member through which theinsertion part of the second medical instrument is inserted, wherein thefirst and second entry and exit ports are within the outer tube body,and the first medical instrument passes through the first entry and exitports, while the second medical instrument passes through the secondentry and exit ports, wherein the insertion part of the first medicalinstrument comprises: a part which is to be held by the first holdingpart and has a first diameter A1; and a part which is disposed closer toa distal end than the part having the first diameter A1, and isconfigured to be delivered to protrude out of the first exit port, andhas a second diameter A2 smaller than the first diameter A1.
 2. Thesurgical device according to claim 1, wherein the insertion part of thesecond medical instrument comprises: a part which is to be held by thesecond holding part and has a first diameter B1; and a part which isdisposed closer to a distal end than the part having the first diameterB1, and is configured to be delivered to protrude out of the second exitport, and has a second diameter B2 smaller than the first diameter B1.3. The surgical device according to claim 2, wherein the outer tubefurther includes a second sealing member which is provided at the secondentry port and configured to slidably seal the insertion part of thesecond medical instrument, and the insertion part of the second medicalinstrument further includes a part which is disposed closer to aproximal end than the part having the first diameter B1, and isconfigured to maintain hermeticity with the second sealing member, andhas a third diameter B3 larger than the first diameter B1.
 4. Thesurgical device according to claim 2, wherein the outer tube furtherincludes a second sealing member which is provided at the second entryport and configured to slidably seal the insertion part of the secondmedical instrument, and the insertion part of the second medicalinstrument further includes a part which is disposed closer to aproximal end than the part having the first diameter B1, and isconfigured to maintain hermeticity with the second sealing member, andhas a third diameter B3 smaller than the first diameter B1.
 5. Thesurgical device according to claim 1, wherein the first medicalinstrument is an endoscope.
 6. The surgical device according to claim 1,wherein the first holding part includes an annular elastic memberthrough which the insertion part of the first medical instrument isinserted, and which is configured to hold the insertion part of thefirst medical instrument by means of an elastic force, and the firstexit port has an inner diameter smaller than an inner diameter of theelastic member.
 7. The surgical device according to claim 1, wherein themovable object comprises: a movable object main body configured to bemovable with respect to the outer tube body in the axial direction; anda movable part configured to be movable with respect to the movableobject main body in the axial direction, and one of the first holdingpart and the second holding part is provided in the movable part, andanother one of the first holding part and the second holding part isprovided in the movable object main body.
 8. The surgical deviceaccording to claim 1, wherein the outer tube further includes a firstsealing member which is provided at the first entry port and configuredto slidably seal the insertion part of the first medical instrument, andthe insertion part of the first medical instrument further includes apart which is disposed closer to a proximal end than the part having thefirst diameter A1, and is configured to maintain hermeticity with thefirst sealing member, and has a third diameter A3 smaller than the firstdiameter A1.
 9. The surgical device according to claim 1, wherein theouter tube further includes a first sealing member which is provided atthe first entry port and configured to slidably seal the insertion partof the first medical instrument, and the insertion part of the firstmedical instrument further includes a part which is disposed closer to aproximal end than the part having the first diameter A1, and isconfigured to maintain hermeticity with the first sealing member, andhas a third diameter A3 larger than the first diameter A1.
 10. An outertube adapted to guide an insertion part of a first medical instrumentand an insertion part of a second medical instrument into a body cavity,the outer tube comprising: a cylindrical outer tube body into which theinsertion part of the first medical instrument and the insertion part ofthe second medical instrument are configured to be inserted; a firstentry port provided at a proximal end part of the outer tube body; asecond entry port provided at the proximal end part of the outer tubebody; a first exit port provided at a distal end part of the outer tubebody; a second exit port provided at the distal end part of the outertube body; a movable object which is arranged in the outer tube body andis configured to be movable in the outer tube body in an axialdirection; a first holding part which is provided at the movable objectand configured to hold the insertion part of the first medicalinstrument inserted into the outer tube body; and a second holding partwhich is provided at the movable object and configured to hold theinsertion part of the second medical instrument inserted into the outertube body, wherein the first holding part includes a first annularelastic member through which the insertion part of the first medicalinstrument is inserted, and the second holding part includes a secondannular elastic member through which the insertion part of the secondmedical instrument is inserted, wherein the first and second entry andexit ports are within the outer tube body, and the first medicalinstrument passes through the first entry and exit ports, while thesecond medical instrument passes through the second entry and exitports, wherein the insertion part of the first medical instrumentcomprises: a part which is to be held by the first holding part and hasa first diameter A1; and a part which is disposed closer to a distal endthan the part having the first diameter A1, and is configured to bedelivered to protrude out of the first exit port, and has a seconddiameter A2 smaller than the first diameter A1.
 11. The outer tubeaccording to claim 10, wherein the insertion part of the second medicalinstrument comprises: a part which is to be held by the second holdingpart and has a first diameter B1; and a part which is disposed closer toa distal end side than the part having the first diameter B1, and isdelivered to protrude out of the second exit port, and has a seconddiameter B2 smaller than the first diameter B1.
 12. The outer tubeaccording to claim 11, further comprising a second sealing member whichis provided at the second entry port, and is configured to slidably sealthe insertion part of the second medical instrument, wherein theinsertion part of the second medical instrument further includes a partwhich is disposed closer to a proximal end than the part having thefirst diameter B1, and is configured to maintain hermeticity with thesecond sealing member, and has a third diameter B3 smaller than thefirst diameter B1.
 13. The outer tube according to claim 11, furthercomprising a second sealing member which is provided at the second entryport, and is configured to slidably seal the insertion part of thesecond medical instrument, wherein the insertion part of the secondmedical instrument further includes a part which is disposed closer to aproximal end than the part having the first diameter B1, and isconfigured to maintain hermeticity with the second sealing member, andhas a third diameter B3 larger than the first diameter B1.
 14. The outertube according to claim 10, wherein the movable object comprises: amovable object main body configured to be movable with respect to theouter tube body in the axial direction; and a movable part configured tobe movable with respect to the movable object main body in the axialdirection, and one of the first holding part and the second holding partis provided in the movable part, and another one of the first holdingpart and the second holding part is provided in the movable object mainbody.
 15. The outer tube according to claim 10, further comprising afirst sealing member which is provided at the first entry port, and isconfigured to slidably seal the insertion part of the first medicalinstrument, wherein the insertion part of the first medical instrumentfurther includes a part which is disposed closer to a proximal end thanthe part having the first diameter A1, and is configured to maintainhermeticity with the first sealing member, and has a third diameter A3smaller than the first diameter A1.
 16. The outer tube according toclaim 10, further comprising a first sealing member which is provided atthe first entry port, and is configured to slidably seal the insertionpart of the first medical instrument, wherein the insertion part of thefirst medical instrument further includes a part which is disposedcloser to a proximal end than the part having the first diameter A1, andis configured to maintain hermeticity with the first sealing member, andhas a third diameter A3 larger than the first diameter A1.